Confusion and Psychosis-Like Symptoms After ECT: Benzodiazepine Withdrawal or Prolonged Post-ECT Delirium?

Kylie Cheng

doi:10.3928/00485713-20211017-01

Factors affecting hallucinations in patients with delirium

Scientific Reports ◽

10.1038/s41598-021-92578-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Masako Tachibana ◽

Toshiya Inada ◽

Masaru Ichida ◽

Norio Ozaki

Keyword(s):

Rating Scale ◽

Detailed Examination ◽

Individual Factors ◽

Visual Hallucinations ◽

Angiotensin Ii Receptor ◽

Contributing Factors ◽

Factors Affecting ◽

Receptor Blockers ◽

Benzodiazepine Withdrawal ◽

Exogenous Substances

AbstractDelirium develops through a multifactorial process and include multiple subtypes with different pathological factors. To refine the treatment and care for delirium, a more detailed examination of these subtypes is needed. Therefore, this study aimed to explore the factors affecting delirium in cases in which hallucinations are conspicuous. In total, 602 delirium cases referred to the psychiatry department at a general hospital between May 2015 and August 2020 were enrolled. The Delirium Rating Scale-revised-98 was used to assess perceptual disturbances and hallucinations in patients with delirium. Multiple regression analysis was applied to determine whether individual factors were associated with the hallucinations. A total of 156 patients with delirium (25.9%) experienced hallucinations, with visual hallucinations being the most common subtype. Alcohol drinking (p < 0.0005), benzodiazepine withdrawal (p = 0.004), and the use of angiotensin II receptor blockers (p = 0.007) or dopamine receptor agonists (p = 0.014) were found to be significantly associated with hallucinations in patients with delirium. The four factors detected in this study could all be reversible contributing factors derived from the use of or withdrawal from exogenous substances.

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Inhibition of NMDA receptors by agmatine is followed by GABA/glutamate balance in benzodiazepine withdrawal syndrome

Beni-Suef University Journal of Basic and Applied Sciences ◽

10.1186/s43088-021-00125-8 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hira Rafi ◽

Hamna Rafiq ◽

Muhammad Farhan

Keyword(s):

Mechanism Of Action ◽

Withdrawal Syndrome ◽

Substance Dependence ◽

Screen Test ◽

Underlying Mechanism ◽

Depressive Mood ◽

Elevated Plus Maze Test ◽

Plus Maze ◽

Compulsive Behaviors ◽

Benzodiazepine Withdrawal

Abstract Background Drug withdrawal syndrome occurs due to abrupt cessation of an addictive substance. Dependence to diazepam can be manifested by withdrawal syndrome which may include symptoms such as irritability, psychosis, sleep disturbance, seizures, mood disturbance, and anxiety. Studies have described the therapeutic role of agmatine in various neurological disorders such as depressive mood, learning deficits, anxiety, memory impairment, and psychosis. Various studies have also validated agmatine as a putant neuromodulator and revealed its mechanism of action with other neurotransmitters. The study was designed to reveal the potentials of agmatine in benzodiazepine withdrawal syndrome by maintaining GABA/glutamate balance. The study aimed to determine the underlying mechanism of action of agmatine at synaptic level using behavioral and biochemical evaluations. Results Agmatine significantly enhanced locomotion in open filed test and decreased anxiety as observed in elevated plus maze test (p < 0.01). Agmatine also reduced withdrawal symptoms scores along with compulsive behaviors in marble burying test and improved muscular strength by decreasing latency to fall in inverted screen test (p < 0.01). Moreover, agmatine established GABA/glutamate balance by increasing GABA levels and decreased glutamate concentration significantly (p < 0.01). Conclusion The present study reveals the possible mechanism of action of agmatine on NMDA receptor at GABA interneurons and glutamate post synaptic neuron that may lead to GABA/glutamate balance during withdrawal syndrome.

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Interventions for benzodiazepine withdrawal: Perceptions of benzodiazepine counsellors

Counselling and Psychotherapy Research ◽

10.1002/capr.12453 ◽

2021 ◽

Author(s):

Gerald Wurf ◽

Alice Swing

Keyword(s):

Benzodiazepine Withdrawal

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COPING WITH BENZODIAZEPINE WITHDRAWAL SYMPTOMS

InPharma ◽

10.1007/bf03312078 ◽

1981 ◽

Vol 281 (1) ◽

pp. 11-11

Keyword(s):

Withdrawal Symptoms ◽

Benzodiazepine Withdrawal

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Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal

Case Reports in Cardiology ◽

10.1155/2016/8153487 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Teng J. Peng ◽

Nicholas D. Patchett ◽

Sheilah A. Bernard

Keyword(s):

Emergency Department ◽

Takotsubo Cardiomyopathy ◽

Aminobutyric Acid ◽

Single Patient ◽

Cardiac Enzymes ◽

T Wave ◽

Daily Dose ◽

Benzodiazepine Withdrawal ◽

Sudden Decrease ◽

Careful History

We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease inγ-aminobutyric acid (GABA) signaling during benzodiazepine withdrawal.

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